Provider Demographics
NPI:1760468607
Name:CHRIQUI, KATHY (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:CHRIQUI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 PLUMMER ST
Mailing Address - Street 2:STE 300
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2139
Mailing Address - Country:US
Mailing Address - Phone:818-882-9300
Mailing Address - Fax:818-882-9257
Practice Address - Street 1:19600 PLUMMER ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2139
Practice Address - Country:US
Practice Address - Phone:818-882-9300
Practice Address - Fax:818-882-9257
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA8439T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA362ZMedicare PIN
U17687Medicare UPIN